EECP offers possible relief for chest pain

Over the last year, Fred Lembkie, 62, has had three heart attacks, a failed bypass surgery, two subsequent angioplasty procedures and stents inserted into his arteries.

When the Portland, Ore., man finally underwent EECP treatment, a little-known, often last-ditch therapy for chronic chest pain, he had one question for his doctors: Why didn't anyone tell me about this earlier?

EECP, which stands for Enhanced External Counterpulsation, is a nonsurgical technique used to increase blood flow to the heart. It may help reroute blood around narrowed or blocked arteries.

During the treatment, the patient's legs are wrapped in compressive pneumatic cuffs. The devices squeeze and release — inflating and deflating — to the beat of the heart, pushing oxygenated blood toward the ticker and into the coronary arteries. The typical treatment lasts an hour.

Patients undergo 35 sessions over a course of seven weeks.

The therapy is often offered to those who have maxed out on their medicine or aren't candidates for surgical interventions. It's for the patients like Lembkie who hear, "there's nothing more we can do" for their chest pain.

EECP treatment is "medicine's best kept secret," said physician Debra Braverman, director of EECP at the Albert Einstein Medical Center in Philadelphia, who recommends it as a first-line treatment in a 2012 review published in the journal Complementary Therapies in Clinical Practice. "Patients who receive EECP are better, feel better and require less physician intervention," she said.

EECP mimics the vascular effects of aerobic exercise, research shows. EECP, which provides passive exercise, can be used as a bridge to regain an active lifestyle for patients with chronic chest pain, Braverman wrote in the review.

Braverman suspects the treatment has been slow to catch on because "there is a financial disincentive to promote this non-invasive treatment," she said. "It's low cost relative to other treatments for the same disease," she said.

Gold standard trials — randomized and placebo-controlled, held at multiple sites — have found the treatment to be "generally well tolerated and efficacious; Anginal symptoms were improved in approximately 75 percent to 80 percent of patients," according to the American Heart Association.

But it also said additional clinical trial data are necessary before it could be recommended definitively.

The procedure has been proved to temporarily relieve chest pain but not necessarily prevent heart attacks or save lives, said preventive cardiologist Stephen Devries, executive director of the Gaples Institute, a nonprofit that promotes integrative cardiology. "The theory is that the mechanical pressure on the blood vessels in the legs gets transmitted all the way back to the blood vessels in the heart and forces them open," he said.

Still, traditional invasive procedures, including angioplasty and stents, haven't been shown to save lives either, unless performed in the midst of a heart attack, Devries said.

About 600 centers offer EECP in the U.S., according to Louanne Tempich, president of the International EECP Therapists Association, a group of practitioners trained using specific equipment manufactured by the medical technology company Vasomedical and approved by the Food and Drug Administration.

For most people, the benefits of EECP last for several years; approximately 40 percent of patients require another round of therapy within the first three to five years, depending on their condition, said Braverman, who has seen the improvements last for as long as a decade.

The majority of insurance companies pay for EECP, including Medicare.

Lembkie, who finished his last treatment in early February, called the first few days of therapy an "extremely unusual" experience.

"It's sort of a violent hug," he said, because the bags around the body abruptly inflate. "When the machine fires (with each heartbeat), it actually bounces you a little bit," he said. "But you get used to it when you understand there aren't any other options."

After the first few days, Lembkie said he could breathe deeply and clearly. Within weeks, he was walking better than he had been in months and felt he'd never had problems. He's not sure how long the effect will last. But he said if he'd found the treatment six months earlier, he'd been spared significant "depression, anxiety and pain."

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